Why Not Kratom?

Can you tell me anything about kratom? I understand it can help treat addiction to opioids as well as relieve pain? Is it safe to use?

– February 5, 2018

Kratom is the leaf of a tree (Mitragyna speciosa) native to Southeast Asia. Preparations of it have long been used in that region to boost energy and relieve pain as well as to treat a range of other ailments. Its use has been growing in the U.S. in recent years for pain relief and also to help with withdrawal from opioids.

Kratom made the news in November (2017) when U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, M.D. warned against its use, particularly by people addicted to heroin and other opioids. He noted that the agency is aware of reports of kratom supplements being laced with opioids such as hydrocodone and also warned that using it can lead to serious side effects, including seizures, liver damage and withdrawal symptoms. Reportedly, kratom products are being sold widely in smoke shops and elsewhere in the form of a powder meant to be consumed as tea to slow the effects of opioid withdrawal. In his warning statement, Commissioner Gottlieb cited 36 deaths due to kratom, although it isn’t clear that kratom alone was responsible.

A bit of background on this subject: in September 2016 the U.S. Drug Enforcement Administration (DEA) put on hold its proposed ban on the use of kratom and the decision to place it in Schedule 1 of the Controlled Substances Act, which includes heroin, ecstasy and LSD. This highly unusual postponement came in response to pressure from U.S. congressmen and senators, members of the public and representatives of the scientific community. The key issue was the effect a ban would have on ongoing research into whether kratom’s properties can yield more effective – and less addictive – painkillers than morphine, Oxycontin and other opioids. Research is ongoing at Columbia University and Memorial Sloan-Kettering Cancer Center and elsewhere. The scientific evidence to date suggests that compounds in kratom are potent painkillers with less addictive potential than opioids. There are currently no FDA-approved therapeutic uses of kratom.

So far, most of the scientific evidence showing that kratom may have opioid-like activity comes from animal studies, although the effects in humans are reported to resemble those of opioids. However, unlike opioids, which are mainly sedating, at low and moderate doses kratom appears to have mildly stimulating effects. Kratom does not produce an opioid-like high, but suddenly stopping its use can lead to withdrawal symptoms though these are said to be milder than those associated with quitting opioids.

At this writing, no controlled clinical trials have been published on the safety and efficacy of kratom in humans for pain control or opioid withdrawal. And because there’s no doubt that some kratom products are adulterated – in some cases with toxic drugs – it is impossible to say for sure whether supplements containing kratom are safe.

Andrew Weil, M.D.

 

Source:
Walter C. Prozialeck, “Update on the Pharmacology and Legal Status of Kratom.” Journal of the American Osteopathic Association, December 2016, doi:10.7556/jaoa.2016.156

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